Thursday, February 15, 2018

Representatives and volunteers with the American HeartAssociation and the state chapter of the American Collegeof Cardiology rallied in Frankfort on Valentine's Day to urgelawmakers to raise the cigarette tax by $1 for heart health.

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. -- At a Feb. 14 rally in the state Capitol, advocates for heart health urged lawmakers to raise Kentucky's cigarette tax as a way to reduce smoking, a known cause of heart disease.

"We are here on Valentine's Day, the day which celebrates love, to ask our legislators and governor to do something that will have a profound and long lasting impact on the health of all of us Kentuckians," said Dr. Andy Henderson, president of the American Heart Association's Central Kentucky Board of Directors. "We are asking them to protect the hearts of all Kentuckians by raising the tax on cigarettes by at least $1 per pack."

Smoking kills about 9,000 Kentuckians every year, with about one-third of those deaths from heart disease caused by smoking or second-hand smoke, according to the AHA. It is also responsible for many other heart related diseases, including stroke and chronic obstructive pulmonary disease (COPD), of which Kentucky has the second highest rate in the nation.

Republican Sen. Ralph Alvarado, a Winchester physician, told the advocates that "the message is starting to soak in" with legislators, especially this budget year that is trying to address such a huge deficit. He noted that this tax, which would raise $266 million, could help to fill a half-billion-dollar gap.

Alvarado, who has sponsored several anti-tobacco bills, pointed out that support for raising the cigarette tax by $1 is backed by 70 percent of Kentuckians, the Kentucky Chamber of Commerce, medical groups and the education system.

"We've got to do something to help reduce our youth smoking [rates], which are the worse in the country, and adult smoking rates and this would help us get there," he said."Continue to be advocates, contact your legislators and let them know what your stance is, advise them on how they could use those funds to help us with the current budget crisis."

Henderson, who is also the CEO of Lexington Clinic, reminded the crowd that Kentucky has some of the highest smoking rates in the nation for both teens and adults. He said raising the cigarette tax by $1 a pack would not only keep teens from smoking, but would cause an estimated 2,900 smokers to quit, saving the state an estimated "millions and millions of dollars in health care costs year after year." The Campaign for Tobacco-Free Kids estimates that raising the tax by $1 would result in 23,200 fewer Kentucky teens smoking.

Henderson said that he primarily supported this measure for its many health benefits, but added that there was no denying it would bring new revenue to a state that sorely needs it.

Withrow wields cigarette(Melissa Patrick photos)

"I've heard our leaders say they don't want any new taxes. This is not a new tax and no-one is being forced to pay the tax. If you don't want to pay it, don't smoke. It's that simple," he said.

While holding a huge mock-up of a cigarette, Dr. Patrick Withrow of Paducah, the 2018 governor-elect of the Kentucky chapter of the American College of Cardiology, also called on the state's lawmakers to raise the tax, noting that at 60 cents a pack, Kentucky has one of the lowest cigarette taxes in the nation. The national average is $1.72 per pack.

"The cigarette smoking tax is a win-win-win," said Withrow, a long-time volunteer of the American Heart Association. "It will improve the health of Kentuckians. It will reduce tobacco use. It will lower health care cost and it will help businesses -- and it will improve the coffers."

The rally was the fourth in a series sponsored by the Coalition for a Smoke-Free Tomorrow, which comprises nearly 150 organizations that support efforts to decrease smoking in the state, including the tax hike. The other rallies have focused on smoking and pregnancy, teenagers and behavioral health. The next rally, set for 11 a.m. Feb. 21 in the Capitol rotunda, will focus on smoking and cancer.

Wednesday, February 14, 2018

Most Kentucky adults, by far, want schools to be tobacco-free -- and bills to do just that have been introduced in the Senate and the House.

The latest Kentucky Health Issues Poll, taken Oct. 24 to Dec. 2, found that 87 percent of Kentucky adults favor tobacco-free campuses. Support was strong across party lines, with 89 percent of Democrats, 87 percent of Republicans and 82 percent of independents. The poll also found strong support among those with and without children in their homes: 90 percent and 85 percent, respectively.

The poll has shown consistent support for tobacco-free school policies since 2013, but only 39 percent of the state's school districts (with 55 percent of the state's total students) are covered by comprehensive tobacco-free school policies, according to the state Department for Public Health's Tobacco Prevention and Cessation Program.

Smoke-free school policies are decided by local school boards, but that would change with enactment of Senate Bill 51 or House Bill 318, which would prohibit tobacco products on school properties and at school events. Both bills are still in each chamber's education committee.

The Kentucky School Boards Associationtold Kentucky Health News in November that it would support any legislation that proposes a statewide tobacco-free school law in the 2018 legislative session, because 81 percent of their members support it.

Last year, the Senate bill's main sponsor, Republican Sen. Ralph Alvarado of Winchester, introduced a bill that passed the Senate but died in the House Education Committee.

Alvarado said Senate leaders have told him that the bill needs to pass out of the House first this year, and if it does, he said he thinks it will pass in the Senate.

"My question is, who are the 13 percent who don't support this?" he asked."That's what it comes down to."

Rep. Kim Moser, R-Taylor Mill, who is sponsoring the House version of the bill, said in an e-mail that she has asked Education Committee Chair Rep. John "Bam" Carney, R-Campbellsville, if she can get HB 318 heard, but hasn't heard back from him.

According to the 2017 Youth Risk Behavior Survey, 26 percent of Kentucky high school students regularly (defined as at least one day during the past 30 days) use either cigarettes, electronic cigarettes, cigars or smokeless tobacco, with about 14 percent each using using cigarettes and e-cigs. The numbers are much higher, 40.5 and 44.5 percent, respectively, when students are asked if they have "ever" used e-cigs or cigarettes. The survey found that 45.8 percent of Kentucky high-school students who used any kind of tobacco product, including e-cigarettes, said they had tried to quit. Research shows that strong tobacco-free school policies can discourage youth from smoking and can also help those who want to quit.

Recent studies also show that e-cigarette use among youth can lead to smoking cigarettes.

"We were making great headway in reducing youth smoking until e-cigarettes made tobacco use somewhat socially acceptable again," said Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky, which co-sponsored the poll. "It is imperative that we send the message to Kentucky's youth that using tobacco of any kind is dangerous. We can reinforce that message by ensuring that students don't see their peers, teachers and role models smoking and using tobacco on school grounds."

The poll, co-sponsored by Cincinnati's Interact for Health, interviewed 1,692 Kentucky adults by landlines and cell phones. The margin of error for each result is plus or minus 2.4 percentage points.

Gov. Matt Bevin's administration plans to spend $374 million over the next two years, most of it federal money, to implement changes in the Medicaid program for which Bevin won federal approval last month, reports Deborah Yetter of the Courier Journal.

"It has added $186 million to the current budget and proposes $187 million in the next budget year starting July 1 for administrative costs, most of the money associated with the Medicaid changes," Yetter reports. Part of the administrative costs added to this year's budget would go toward creating a Medicaid computer system required by the federal government."

"Much of the money will go to adding technology to track compliance with new rules that require some people on Medicaid to work, train for jobs or volunteer at least 20 hours a week and pay monthly premiums," Yetter adds. "Those changes are expected to affect fewer than 200,000 people out of the 1.4 million Kentuckians enrolled in the federal-state health plan. Critics of the plan argue that's a lot of money for a plan aimed at a small fraction of the Medicaid population."

In his campaign and early in his term, the Republican governor said the expansion of Medicaid by his predecessor, Democrat Steve Beshear, was not sustainable and the program needed to be changed to save money. Now he and his lieutenants say the changes aren't intended to save money, but to steer people into jobs that include health insurance.

Tim Feeley, deputy secretary of the Cabinet for Health and Family Services, told a legislative panel recently, "The goal here is to get people working and off Medicaid and into private insurance, to improve their health and give them the satisfaction of working." Yetter notes, "Advocates argue the majority of those in Kentucky affected by the changes already work at low-wage or part-time jobs with no health coverage."

Medicaid Commissioner Stephen Miller told a budget subcommittee last week that the changed won't save any money in the two-year budget that begins July 1, but in the following three years -- the extent of the federal approval -- the savings will total $2.1 billion in federal funds and $300 million in state money, Yetter reports.

Gov. Matt Bevin's proposed budget for the next two fiscal years calls for cuts to five cancer research and prevention programs, including screenings for breast, colon, cervical, lung and ovarian cancer, and for research on lung cancer, all of which plague the state.

The programs are included in a list of 70 that Bevin proposed to eliminate to save the state $85 million, or less than 1 percent of the overall budget. He has said these cuts are necessary to help fund the state's ailing pension system.

Dr. Whitney Jones, a Louisville gastroenterologist and founder of the Kentucky Cancer Foundation, which provides funds for colon-cancer screening, said he recognizes the challenges of balancing a state budget, but hopes the state will reconsider eliminating the colon cancer screening and prevention program. He said of Bevin, "We hope this is just his first position."

Jones, who also founded the Colon Cancer Prevention Project in Louisville, called the state's improvement from 49th to 19th for colo-rectal screening in the past 15 years, "the best public health story" in Kentucky.

He added that this was only possible because the state offered screenings to uninsured and under-insured Kentuckians, expanded Medicaid to those who earn up to 138 percent of the federal poverty level, and has a unique, multi-partner screening program -- all of which he said makes Kentucky "the envy of most states in the nation."

But he also said there is still work to be done, because Kentucky still leads the nation in colon cancer and remains in the top 10 for colon-cancer deaths.

Doug Hogan, a spokesman for the state Cabinet for Health and Family Services, said the state's screening programs, including those for colon, breast and cervical cancer, are no longer needed because they are now covered by all insurance plans with no deductibles or co-payments.

Jones acknowledged that the program needs to be restructured because of the Medicaid expansion, but argues that it is still necessary for several reasons. He said Kentucky still has a large number of people without health insurance; the federal law that requires almost all Americans to have insurance or pay a tax penalty will be repealed at the end of the year; the coming work requirements and premiums in Medicaid will lead to some people going without coverage; and there will be a continuing need for education and outreach about cancer and screening.

"There has to be a better way to cut out the bad and support or maintain the good," Jones said. "And I would just suggest that the Kentucky Colon Cancer Screening Program is the baby, and not the bathwater."

Lung cancer research targeted in a state that has the most of it
Another program set to lose about $5 million is the Lung Cancer Research Grant Program, a collaboration between the University of Kentucky and University of Louisville that is funded by funds from states' 1998 settlement with cigarette manufacturers. UK's portion is $2.4 million, spokesman Jay Blanton said.

Dr. Mark Evers of UK's Markey Cancer Institute said this statewide initiative seeds a number of pilot projects and "spans the gamut" from new lung-cancer therapies and treatments to new clinical trials and prevention strategies, such as lung-cancer screening. He said such pilot programs are often used to help get larger grants from the National Institutes of Health and other sources.

Evers noted that the Kentucky Lung Cancer Education Awareness Detection Survivorship Collaborative (the Kentucky LEADS Collaborative for short), now funded by a $7 million Bristol-Myers Squibb Foundation grant, is a great example of how a pilot project from this research grant program was able to get a larger grant to further its work.

"It really is a valuable mechanism for us to provide pilot funding for investigators to get the initial data so that they can carry that forward in larger extramural grants," Evers said.

He also noted that the research grant program is responsible for the Kentucky Clinical Trials Network, which he described as another joint venture with U of L that "pushes out" clinical trials for lung cancer, which have been conducted in about 90 percent of Kentucky's counties.

Asked if the program could survive without the state funding, Blanton, who sat in on the telephone interview with Evers, said, "We're just trying to get our arms around the numbers right now."

Asked why the program is important, Evers pointed to the state's high smoking rate, second in the nation, and its No. 1 rank in number of lung-cancer cases. "We've got a terrible problem with this in the state," Evers said.

When Kentucky researchers made a pitch to the National Cancer Institute, Evers said, "The first words out of their mouth were, 'What are you guys doing about your smoking problem?' So, it's really incumbent upon us to be able to have the resources to attack this by screening, prevention and treatment."

While Kentucky LEADS is on Bevin's list of programs that would get no state funding in the next two fiscal years, it has never received any, said Jamie Studts, a UK professor of behavioral science and the lead investigator for the collaborative. He said it had been slated to get $10,000 in each year of the current budget, but that Bevin had "red-lined" the allocation.

Studts said that the cut "doesn't directly affect us in terms of dollars, but indirectly it does send a message that the governor and this administration is not interested in making those kinds of efforts to address Kentucky's burden of lung cancer."

Breast and cervical cancer: state squeezes local health departments

As for the screening programs for breast and cervical cancer, Hogan said that in addition to these screenings now being covered by insurance, they are also operated by federal funds, so elimination of any state funds would not impact them.

Allison Adams, president of the Kentucky Health Department Association, said that while it's true that the breast and cervical screening programs have not received any state dollars for several years and get some federal funds, most of their funding for these programs come from local tax dollars.

For example, she said that in the fiscal year that ended in June 2017, local health departments received about $607,000 in federal funding for breast and cervical cancer screening, and the rest came from $2.3 million in local dollars. The programs serve about 20,000 patients a year.

Adams said the real challenge for health departments to continue such programs, or any of the other initiatives that involves direct patient care, is that Bevin's budget has added $38.5 million to their annual pension liability. She said that will force the departments to provide programs that focus on overall health, safety and prevention and look for ways to spend $1 to affect 10 people, instead of $10 to affect one.

"Local health departments need to be working on the prevention piece, and less on the treatment and intervention," Adams said, but they "will have to do their own prioritization and determine which programs have the absolute most health benefit for all of Kentuckians. We really have to make some tough decisions of where we are going to spend our money that's going to have the greater impact over the health of Kentucky."

The Ovarian Cancer Screening Program is also slated to be cut. Linda Blackford of the Lexington Herald-Leaderreports that this UK program offers free vaginal ultrasound screenings to women for ovarian cancer and has provided nearly 50,000 free screenings since its creation 30 years ago.

Blackford notes that the Pediatric Cancer Research Trust Fund, established in 2015 by Sen. Max Wise, R-Campbellsville, has been approved to receive $2.5 million in each year of the biennium to fund pediatric brain cancer research at UK and U of L. Bevin's budget calls for each of the universities to provide a minimum of $1.2 million a year for the program.

Purdue Pharma, the manufacturer of OxyContin, says it will no longer market its opioid drugs with visits to doctors' offices and its halving its sales force. The move comes "after years of criticism and mounting lawsuits . . . claiming its sales practices are partly responsible for the opioid epidemic," reports Ben Poston of the Los Angeles Times.

"It's pretty late in the game to have a major impact," Brandeis University researcher Dr. Andrew Kolodny, a longtime critic of the pharmaceutical industry's role in the opioid epidemic, told Poston. "The genie is already out of the bottle. Millions of Americans are now opioid-addicted because the campaign that Purdue and other opioid manufacturers used to increase prescribing worked well. And as the prescribing went up, it led to a severe epidemic of opioid addiction." The drug went on sale in 1996; in 2007, in federal court in southwest Virginia, Purdue paid $635 million in fines to end an investigation by the U.S. Department of Justice.

Poston writes, "One remaining question is whether other opioid makers will follow suit and cease marketing the drugs to doctors, said Kolodny, executive director and co-founder of Physicians for Responsible Opioid Prescribing."

"In an attempt to stem the abuse of OxyContin, Purdue spent a decade and several hundred million dollars developing a version of the painkiller that was more difficult to snort, smoke or inject," Poston notes. "Since those 'abuse-deterrent' pills debuted seven years ago, misuse of OxyContin has fallen and the company has touted them as proof of its efforts to end the opioid epidemic. But a study released in January 2017 found that rather than curtail deaths, the change in OxyContin contributed heavily to a surge in heroin overdoses across the country and that, as a result, there was 'no net reduction in overall overdose deaths'." States with the most OxyContin abuse rates had the largest increases in heroin deaths. Kentucky is among them.

Under an online headline, "Rush to Impose Medicaid Curbs Creates Unease," health reporter Abby Goodnough of The New York Timestakes a look at the changes coming in Kentucky's Medicaid program.

Mark Lee Coleman's blood is drawn at a Family Health Center.(Photo by Aaron Borton for The New York Times)

Her main example was Mark Lee Coleman, 49, of Louisville, a diabetic who has neuropathy, numbness and tingling in his hands and feet, and sometimes trouble walking. When he went to get health care recently, he found that Medicaid had dropped him from the rolls because he failed to report a change in his employment.

Now he and other Medicaid beneficiaries will have to make monthly reports about their income and work, and if they're no working, do volunteer work or take job training. Coleman works 20 hours a week, but fears his health might force him to work fewer hours, which would take him below the minimum work requirement of 80 per month.

"He’d either have to try to get classified as 'medically frail,' which would exempt him from the work rule, or lose his coverage," Goodnough notes. "He hasn’t thought all that through yet. In concept, though, he supports work requirements — as do most voters, pollshave found.

“That’s not bad, to tell you the truth,” he told Goodnough. “If you’re working, that’s good for your health.”

That's part of the argument for the work rules created by Gov. Matt Bevin with approval of the Trump administration. Their argument "is that Medicaid was created for the most vulnerable citizens — those who aren’t only poor, but pregnant, elderly, children or disabled — and that for everyone else, working or otherwise engaging in their community will provide dignity and better health," Goodnough writes. "About 500,000 Kentuckians have joined the Medicaid rolls under the Obamacare expansion, and the state estimates some 350,000 will be subject to the new work rules."

However, "Many who work with the poor are worried that the thicket of new documentation requirements in Medicaid will be daunting for low-income people, who may have little education and struggle with transportation, paying for cellphone minutes and getting access to the internet," Goodnough reports.

Melissa Mather, the communications director at Family Health Centers, where Coleman gets care, "said she worried that patients like him, who already stumble over Medicaid’s paperwork requirements, will be more lost under the new rules."

Mather's boss, Bill Wagner, listened as state health official Kristi Putnam explained how the changes will be implemented. One example: "The 'rewards dollars' that many will need to earn to get their teeth cleaned or their vision checked? They’ll be tracked through a new online platform, where Medicaid recipients will also be expected to upload their work, volunteer or training hours," Goodnough reports.

“I know it sounds a little bit complicated,” Putnam said. Wagner, "after four years of signing up thousands of people for coverage under the health law’s expansion of the Medicaid program," told the room, “We’re shifting our focus from helping people gain coverage to helping people keep it.”

"Wagner and others say they’re just as concerned about other new rules that will be confusing and hard to follow," Goodnough writes. "For example, many adults who don’t pay their small premiums can be locked out of Medicaid for six months, unless they complete a financial or health literacy course. . . . Critics of the plan point to Indiana, which dropped about 25,000 adults from its Medicaid program from 2015 through 2017 for failing to pay premiums there. About half found other coverage, according to state surveys, typically through a job."

Saturday, February 10, 2018

National experts and some Kentuckians say requiring the "able-bodied" in Medicaid to work, and most in the program to pay premiums, will result in fewer people getting health care from it. One state representative says it's all about saving money; Gov. Matt Bevin says it's not.

One of those Kentuckians is Ronnie Stewart, 62, of Lexington, one of 16 Kentucky Medicaid beneficiaries suing the Trump administration over the changes it allowed in the state. The lawsuit alleges that the new plan violates the 1965 Medicaid Act because it will reduce delivery of health care to poor people who need it.

Stewart, who worked for years as a state social worker, told John Cheves of the Lexington Herald-Leader that his experience leads him to believe that the plan is designed to knock people off the program, not improve their health, as Gov. Matt Bevin says.

"He’s just trying to set up roadblocks so he can trip people up and then knock them off Medicaid to save money. That’s all there is to it,” said Stewart. “When you charge a premium, some people can’t pay it, so off they go. When you make people file a report every month, some people aren’t going to make the deadline, so off they go. It’s all about putting up roadblocks.”

The state's request for the changes estimated that with them, the Medicaid rolls will have 95,000 fewer people in five years than without them, partly because of "non-compliance" with the program's requirements. Medicaid covers 1.4 million Kentuckians, about 480,000 of them on the expanded version under the federal health-reform law. A list of enrollment by type and county in June 2017 is at http://www.uky.edu/comminfostudies/irjci/MedicaidenrollmentbycountyJune%202017.xlsx.

Bevin's plan, called Kentucky HEALTH, was the first in the nation to be allowed to require most "able-bodied" Medicaid recipients to work or volunteer 80 hours a month to keep the health insurance.

Cheves writes that the plan also has other "hurdles" such as monthly reports of employment and income; annual re-enrollments; and a list of activities to complete in order to get dental and vision benefits, which are being dropped from Medicaid's basic coverage.

"Missing a payment or notification could trigger a six-month lockout on basic health coverage," Cheves notes. "Missing the enrollment window could mean waiting nine more months for the next opportunity."

"Health policy experts say Kentuckians are likely to fall off the Medicaid rolls because of the paperwork obstacle course," Cheves reports. "Someone juggling a low-wage job, children and the usual turmoil associated with poverty is unlikely to have time for regular check-ins with Medicaid officials, even assuming they have reliable internet access or transportation to a state office building in their community."

Laura Dague, an economist who studies Medicaid policy at Texas A&M University, told Cheves that research shows that even small premiums discourage enrollment.

“You would think the value of the program would outweigh the cost of paying $10 a month," Dague said. "It’s sort of unexpected that small premiums have such a large effect. They have almost the same effect as large premiums. The implication is that part of the effect of premiums is to basically increase the filing and paperwork demands on the enrollee, and that itself is what is having an effect.”

This was demonstrated in Indiana, which implemented monthly premiums of $1 to $27 for its expansion population in 2015. By October 2017 about 25,000 adults had lost their coverage for failure to make their payments, according toKaiser Health News. Indiana officials estimated, based on surveys of recipients, about half of those who were dis-enrolled found another source of coverage, most often through a job.

At a Feb. 5 news conference, Bevin said that no one was
going to be kicked off of Medicaid, and that there would only be two reasons
Kentuckians would lose their coverage -- and both of those reasons were
good. "Number one, because they don't need it anymore, which
is great," he said. "Or number two, because they don't want to do
anything in exchange for something of value, and that's also good."

In an op-ed for the Louisville Courier Journal, state Rep. Tom Burch, a Democrat who was the longtime chairman of the House Health and Welfare Committee, wrote: "Let’s be honest: Kentucky HEALTH, as the waiver is called, is designed to save the state money, not improve health outcomes for poor and low-income Kentuckians. The savings stem from fewer enrolled participants . . . and not all of these participants will get full-time jobs that come with health benefits. This waiver will also increase bureaucratic red tape for those least able to unravel it."

The Bevin administration disagrees, and told the Herald-Leader that the monthly check-ins will be “streamlined and automated” for people using the internet and those visiting a state office, and that the low monthly premiums "are not intended to be a barrier," but instead will replace co-payments and make the process easier.

"By increasing personal involvement in health-care decisions, members gain skills for long-term success and are empowered to take an active role in their day-to-day health care decisions,” said Adam Meier, Bevin’s deputy chief of staff for policy.

Cheves writes, "In Indiana, data show that Medicaid recipients in the monthly premium plan are more likely to obtain preventive health care, stick to their prescription drug regimes and avoid the emergency rooms for unnecessary visits than Medicaid recipients in the traditional plan that charges co-payments, Meier said."

As for the work requirements, Paige Winfield Cunningham of The Washington Postwrites that Medicaid managed-care companies aren't concerned about the new rules because they will affect so few people.

Jeff Meyers, president of Medicaid Health Plans of America, acknowledged that the work requirements will likely result in a drop in enrollment, as it did when they were introduced to welfare in the 1990s, but he expects the drop to be minimal.

“We’re not hyperventilating that millions of people will get thrown off the rolls,” Meyers told Cunningham. “We just want to make sure as states do this, they understand there is a cost involved.”

Tom Miller, a health-care fellow at the conservative American Enterprise Institute, told Cunningham that he estimates work requirements might affect up to 20 to 30 percent of the Medicaid population.

Nationally, most Medicaid beneficiaries work, mostly at low-wage jobs that don't offer health insurance, and those that aren't will fill one of the exemptions for the work requirements according to the Kaiser Family Foundation. Kentucky figures indicate likewise for the state.

Bevin said when he was running for governor in 2015 that some able-bodied Kentuckians were choosing to stay home and play video games, and not working, in order to qualify for Medicaid.

Emily Badget and Margot Sanger-Katz of The New York Timesrecently wrote that the idea that "able-bodied" people "don't want to do anything for something of value" is tied to a long history of thinking that separates the deserving and the undeserving poor. The authors say "able-bodied" is a political term that has long been a descriptor in the food stamp and welfare programs.

“Within that term is this entire history of debates about the poor who can work but refuse to, because they’re lazy,” said Susannah Ottaway, a historian of social welfare at Carleton College in Minnesota. “To a historian, to see this term is to understand its very close association with debates that center around the need to morally reform the poor.”

Doug Hogan, spokesman for the Cabinet for Health and Family Services, disagreed with this depiction of the word "able-bodied."

The phrase "Able-bodied adult is borrowed from existing nomenclature" used in other programs, Hogan said in an email. "This is especially important given the high overlap in enrollment between programs. It has not been used in Medicaid because prior to Medicaid expansion, there were few who would have met this definition. It is not intended to have a negative connotation. It is intended to describe the population as clearly as possible—nothing more, nothing less."

Two churches in Richmond have become sites for the Madison County Health Department's syringe exchange, a program designed to prevent an outbreak of HIV or hepatitis C among intravenous drug users.

Elizabeth Missionary Baptist Church and Revival Tabernacle joined the program in late January. The health department also provides clean needles at its offices in Berea and Richmond.

“Both churches reported a very active drug scene in the area they are located and they thought it would be a good idea, and we did too, to be where the potential participants are,” Jim Thacker, public information officer for the health department, told Jonathan Greene of The Richmond Register.

"With the expansion to the two churches, the program hopes to become more diverse," Greene writes. "The overwhelming majority of participants have been white."

Thacker told Greene, “We want to serve everyone. We always wanted to get in the neighborhoods where we knew there was an issue. All it takes is someone willing to host us. We wanted to get in the community and we were pleased that the faith community reached out to us.”

Elizabeth Deacon Andre Patterson told Greene, “We decided as a congregation that whatever we can do, we will do to help. A lot of the church members have friends or family who have been involved in drugs. It is hard to get them off drugs until they are ready. We’re just trying to help somebody out and give them a second chance.”

"Revival Tabernacle Pastor David Lamb said that, while he has mixed emotions about the exchange, the church is willing to try to help," Greene reports, quoting him: “Although I have reservations, statistics state that those involved in the exchange program are five times more likely to join a recovery program.”

The Register used the news as a way to update readers on the syringe exchange.

Greene reports, "Thacker said participation has been about expected as many in the substance-use community still have a perception the exchange program is a set-up."

Thacker told him, “Potential participants believe they’re going to come in and there will be law enforcement. And that’s not the case at all.” He said the exchange has helped several participants get into recovery programs.

"According to information provided by the health department, participants in the program have been about split between male and female, with heroin being the drug of choice for most," Greene reports. "The age range of participants is 22 to 59. . . . Thacker said nearly three out of five participants are actively employed and most learn about the program from family and friends."

Exchange participants can get tested for hepatitis and HIV without charge. "The testing is just a finger prick and results are typically back in 15 minutes," Greene reports.

February is American Heart
Month, so the state Department for Public Health is encouraging Kentuckians to
increase their physical activity to reduce the risk of heart disease
and stroke. It is promoting the
hashtag #MoveWithHearton social media to connect with others and get information about exercise, physical activity and improving cardiovascular
health.

"Heart disease is the second
leading cause of death among Kentuckians, with more than 10,000 people dying
each year from heart disease," the department said in a news release. "A major risk factor for heart disease is physical
inactivity. Research shows that being physically active can help lower the risk
of heart disease and stroke. When we protect our hearts, we care for our
cardiovascular health. During the cold months, physical activity can be even
more challenging. It’s important that Kentuckians make an effort to move more
throughout the day. "

Federal guidelines suggest physical activity that gets our
hearts beating faster and leaves us a little breathless for at least 2.5 hours each
week. "You can break up that activity into small manageable chunks: 10 minutes
here, 20 minutes there, it all adds up," the health department says. "In addition to physical
activity, these healthy changes can help Kentuckians lower their risk of
developing heart disease:"

Watch your weight.

Quit smoking and stay away from secondhand smoke.

Control your cholesterol and blood pressure.

If you drink alcohol, drink only in moderation.

Get active and eat healthy.

Bonita Bobo, the health department's coordinator for heart disease and stroke prevention, said “All Kentucky children,
women and men should try to build activity into your day by taking the stairs,
parking farther away from your destination, and stepping away from that
computer screen.”

Friday, February 9, 2018

Attorney General Andy Beshear has sued "an alleged rogue drug-treatment clinic for Medicaid fraud, harmful business practices and illegal
distribution of an addictive drug," his office said in a news release.

The Feb. 9 lawsuit in Breathitt Circuit Court charges that owners of The Recovery Center, with clinics in Jackson, Hazard, Mount Sterling, London, Paintsville, Richmond and Frankfort, illegally prescribed a treatment for opioid
addiction to thousands of patients on Medicaid.

The clinics prescribe buprenorphine, branded as Suboxone, as a form of medication-assisted treatment for drug addiction. Beshear said his office recently raided the clinics in Hazard, Jackson, Paintsville and Richmond, and a criminal investigation is continuing.

The civil suit claims that the clinics illegally profited from
the federal-state program by falsely claiming they "offered patients legally
required medical advice and individualized treatment with each prescription," when in fact they were "pill mills . . . strictly operating for profits and couldn’t care less about the health and
safety of our families and neighbors who are struggling with addiction," Beshear said in the news release.

The suit claims the clinics conducted illegal activity from April 2015 through
February 2018. "Under law, a clinic is required to
provide individualized treatment for each patient that includes steps to
decrease dosages over time," the release says. "The Recovery Clinic was billing Medicaid for
spending 15 minutes with each patient in order to diagnose and prescribe, which
is mathematically impossible given the number of prescribing physicians in the
clinics."

For example, the suit claims that on one day in 2017, the Jackson clinic wrote 136 Suboxone prescriptions to Medicaid recipients, all for the same dosage. Claims made in filing a lawsuit give only one side of a case.

FRANKFORT, Ky. -- People with a behavioral-health disorder are more than twice as likely to smoke, and raising Kentucky's cigarette tax by $1 would help them quit, advocates at a rally in Frankfort said Feb. 8.

"Research shows us that when you increase the tobacco tax, even by 10 percent, you are going to see at least an 18 percent reduction in tobacco consumption among people with behavioral-health problems, including people with mental-health issues and substance-abuse disorders," Dr. Chizmuzo T.C. Okoli, an associate professor of nursing the University of Kentucky, said at the Coalition for a Smoke-Free Tomorrow event.

Okoli, an expert on helping people with behavioral disorders quit smoking, said while the nation has seen significant decreases in its smoking rate since the 1960s, from 45 percent to 15 percent, those same gains haven't been made among those with behavioral-health disorders. He said a more concerted effort is needed to help them stop smoking.

Part of the problem in reducing smoking rates among such people is that the cigarette industry has targeted them, according to an anti-smoking group that released videos in August, citing internal tobacco-industry documents showing how cigarette makers purposely targeted people with mental illness.

Sheila Schuster, executive director of Advocacy Action Network, told the small crowd at the rally that 40 percent of people with behavioral-health or substance-use disorders are smokers, and research has found that they are likely to die about five years earlier than smokers without the disorders.

The coalition's news release on the rally noted that smoking kills 8,900 Kentuckians every year, and that nationwide it kills more than 200,000 people living with mental illness.

Ramona Johnson, CEO of Bridgehaven in Louisville, which serves people with psychiatric problems and helps them stop smoking, said their patients have even said they wished tobacco products would cost more.

"They tell us that they almost wish that cigarettes were more expensive because then they wouldn't have to make the decision," she said. "The decision would be made for them because it would be something that they can't afford."

Benjamin Jaggers, a former patient at Bridgehaven who is now a peer-support specialist with the organization, said he took part in a smoking-cessation program while he was a member there. "By using all the tools I learned about . . . I have now been smoke-free for over six months," he said to applause.

Jaggers said he supports raising the cigarette tax in Kentucky by $1. "If you raise the taxes on cigarettes, you might make people with disabilities think twice about buying cigarettes," he said. "That is one of the first steps to quitting, thinking twice about buying that pack of cigarettes."

He added that more resources are needed to help people who want to quit smoking, and suggested that money from the cigarette tax increase could be used to fund such programs. "Quitting smoking is tough," he said.

The rally was the third in a series sponsored by the Coalition for a Smoke-Free Tomorrow, which comprises nearly 150 organizations who support efforts to decrease the smoking rate in the state, including raising the cigarette tax in Kentucky by $1, to $1.60. The first rally focused on smoking and pregnancy and the second one on smoking and teens.

FRANKFORT, Ky. -- The Kentucky General Assembly would be able to pass a law limiting the amount of non-economic damages that could be awarded in personal-injury and wrongful-death lawsuits, under a bill moving to a floor vote in the state Senate.

The House may block the legislation, but a companion bill approved by another Senate committee Feb. 7 would limit the amount of attorney fees in medical-malpractice lawsuits and pose other obstacles to such suits.

Senate Bill 2 is a proposed constitutional amendment, requiring a three-fifths vote in each chamber and approval by a majority of voters in a statewide referendum at the November election. It would negate Section 54 of the 1891 state constitution, which prohibits such limits.

Senate Bill 20 would be a regular law, with several new rules for malpractice cases. In addition to the limit on attorney fees, SB 20 would require a sworn statement from a doctor saying that the lawsuit has merit. Last year, over some Republican opposition in the House, the GOP-controlled legislature required malpractice suits to be reviewed by three medical providers before proceeding. Franklin Circuit Judge Phillip Shepherd has ruled the law unconstitutional. If the law is upheld on appeal, the sworn statement would still be required.

SB 20 would limits contingency fees for plaintiffs' lawyers in malpractice cases, to 35 percent of the first $100,000 awarded, 25 percent of the next $100,000 and 10 percent of the rest. A typical fee in such cases is 33.3 percent. The bill would also keep out of malpractice cases reviews of doctors done by other doctors and any apologies or expressions of regret by heath-care providers.

Sen. Alvarado

“A simple apology can defuse the anger a patient or their family feels when a mistake has occurred,” said Republican Sen. Ralph Alvarado of Winchester, a physician who is sponsoring both bills.

Alvarado told the Senate State and Local Government Committee that doctors and businesses in Kentucky face “unlimited
risk every day” from jury verdicts. “With that risk comes the undeniable fact
that you are one real or perceived accident or mistake away from
watching everything that you have worked for your entire life get taken
away by a single jury decision.”

Kentucky Chamber of Commerce
President David Adkisson told the committee that Kentucky ranks 42nd in the nation for “uncertain legal
liability” because most states have shielded businesses from lawsuits.

Democratic Sen. Morgan McGarvey of Louisville, a lawyer, "challenged Adkisson by saying that neither he nor
Alvarado had shown the senators any data about liability insurance costs
for Kentucky businesses or given any examples of excessive jury awards," John Cheves reports for the Lexington Herald-Leader. McGarvey "said large
trial awards are usually the result of juries disgusted by evidence of
extremely bad conduct, such as children hurt or killed because of
someone’s deliberate indifference."

Sen. McGarvey

“You’ve testified in front of us
today about the businesses that need this for their insurance,” McGarvey
told Adkisson. “When those families are in those hospitals and
funeral homes, will you go testify in front of them and tell them that
the reason we need this is because businesses didn’t want to risk a
lawsuit?”

Adkisson replied, “You’ve editorialized
eloquently . . . but I would stand by everything that
I’ve said, that this is a significant barrier to economic growth.”

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Kentucky Health News is an independent news service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Media at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.Republication of any KHN material with proper credit is hereby authorized, but if the republication is longer than a news brief we ask that it contain the first sentence of this paragraph. Thanks!